From Bright's disease to modern nephrology: Pierre Rayer's innovative method of clinical investigation

Pierre Rayer, in a day of purely descriptive medicine, devised a method for the scientific study of diseases affecting the kidney and urinary tract. He first assembled vivid illustrations of a wide range of disorders of the kidney found in specimens obtained at autopsy. The resulting Atlas won him widespread praise and is still often cited. His Treatise (Traité des Maladies des Reins et des Altérations de la Sécrétion Urinaire), in which he integrated data from pathological anatomy with urinary biology and clinical manifestations, was ahead of its time. Hence it was poorly understood and, like the work of many other innovators, was largely ignored. Nevertheless, his 2100 page Traité which begins with a description of his innovative and highly disciplined method of study, most unusual at this time, is by no means lacking in interest for today's nephrologists. Rayer's was a landmark contribution, affording, as it did, a comprehensive approach to the clinical problems of nephrology a century before the diseases themselves could be understood. Could a contemporary of Rayer tell that he was an inventor of scientific methodology before the proof of his rigorous demonstrations was carried out? That has been the achievement of clinical nephrology in the past forty years...one century later.